/clinical/,/clinical/cckm-tools/,/clinical/cckm-tools/content/,/clinical/cckm-tools/content/cpg/,/clinical/cckm-tools/content/cpg/npg/,

/clinical/cckm-tools/content/cpg/npg/name-98979-en.cckm

201711331

page

100

UWHC,UWMF,

Clinical Hub,UW Health Clinical Tool Search,UW Health Clinical Tool Search,Clinical Practice Guidelines,Nursing Practice Guidelines

Prevention of Catheter-Associated Urinary Tract Infection Guideline at a Glance (Nursing Practice Guideline)

Prevention of Catheter-Associated Urinary Tract Infection Guideline at a Glance (Nursing Practice Guideline) - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Clinical Practice Guidelines, Nursing Practice Guidelines




1








Guideline Title: Prevention of Catheter-Associated Urinary Tract Infection

Effective Date: February 2017
Approved By: Nursing Practice Guidelines Committee; Nursing Practice Council

I. Guideline Overview

This content is extracted from the adopted source document: Wald, H.L., Fink, R.M., Makic, M.B., &
Oman, K.S. (2016). Prevention of Catheter-Assocated Urinary Tract Infection. In M. Boltz, E. Capezuti,
T. Fulmer & D. Zwicker (Eds.), Evidence-based geriatric nursing protocols for best practice 5
th
Edition
(pp. 363-380). New York, NY: Springer Publishing Company, LLC. Please refer to the source guideline
for complete information.
Target Population: Adults age 18 and Older, at risk for use of indwelling urinary catheter
Nursing Practice Guideline Objectives

To provide a standard of practice protocol to ensure that nurses in acute care are able to:
• Define catheter-associated urinary tract infection (CAUTI)
• Describe the epidemiology of CAUTI
• Define indications for indwelling urinary catheters (IUC)
• Identify evidence-based strategies and interventions for the prevention of CAUTI
• Describe key components of a nurse-driven protocol for IUC removal
• Understand how to engage an interdisciplinary team in the management of CAUTIs in the
setting

Clinical Questions Considered

Not provided by source document.

Definitions
UW Health recognizes the surveillance definitions provided in the January 2017 document by the
Centers for Disease Control and Prevention: Urinary Tract Infection (Catheter-Associated Urinary
Tract Infection [CAUTI] and Non-Catheter-Associated Urinary Tract Infection [UTI]) and Other
Urinary System Infection [USI] Events – found on page 2.

II. Practice Recommendations
These guideline recommendations are based on an expert systematic review of the evidence. The
synthesis of available literature is published within a textbook of evidence-based protocols that does
not include the strength of each individual recommendation. The sources of evidence are listed within
the full text reference list and the tally of evidence used is included in section IV.
Twenty percent to 69% of CAUTIs are preventable through the application of evidence-based care
strategies.
Catheter Avoidance
• Established insertion guidelines
• Alternative strategies to manage urine output available:
o Bedside commodes
o Condom catheters

University of Wisconsin Hospitals and Clinics
Nursing Practice Guideline At-a-Glance


Copyright © 201� University of Wisconsin Hospitals and Clinics Authority
Contact: Last Revised: 02/2017EArsenaultknudsen@uwhealth.org
2
o Moisture-wicking incontinence pads
o Intermittent straight catheterization
o Bladder scanner for monitoring and assessment
o Bedpans and urinals that are functional
o Toileting schedules and frequent nursing rounds
Product Selection and Routine Care
• Catheter material:
o Antimicrobial catheter materials have been shown to reduce catheter-associated bacteriuria
(colonization), but impact on prevention of symptomatic CAUTIs during short-term
insertions is unproven.
o There is insufficient evidence to determine whether selection of a latex catheter, hydrogel-
coated latex catheter, silicone-coated latex catheter, or all-silicone catheter influences
CAUTI risk.
• Select the smallest size possible (less than 18 French).
• Use aseptic technique and sterile product during catheter insertion.
• Routine urethral meatus cleansing with soap and water during bath and after bowel movement.
• Secure catheter to leg using a catheter securement device.
• Maintain a closed system at all times.
• Keep drainage bag below level of bladder.
• Empty the bag when two-thirds full and before transport.
Timely Removal
• Systems that prompt providers to review the need for the catheter and encourage early
removal. Examples include stop orders and reminder systems: audit and feedback, nurse-
prompted reminders, and nurse-driven removal protocols.
• Measure of removal: [Surgical Care Improvement Project] SCIP, SCIP-inf-9 measure; catheter
removal on postoperative day 1 or 2.
Surveillance and Education
• Measurement of processes and outcomes.
• Ongoing system evaluation, nursing reeducation, practice reminders, and public reporting of
unit-based CAUTI rate data are strategies to inform the health care team of current practice
outcomes and effectiveness of CAUTI prevention strategies.
III. Pertinent Resources
A. Policies and Protocols
• UWHC Policy 3.14, Sterile Intermittent Catheterization Program
• UWHC Policy 3.31, Insertion, Removal and Maintenance of an Indwelling Urinary
Catheter (IUC)
• UW Health Clinical Policy, 2.5.2, Collecting a Urine Specimen
• Standard Procedures for Urine Specimen Collection
• UWHC Policy 13.12A, Basic Care Standards (Inpatient Adult)
• UWHC Protocol 25, Indwelling Urinary Catheter Removal – Inpatient – Adult
• UWHC Protocol 26, Bladder Management – Inpatient – Adult
• Adult Surgical Services Bladder Scan Guidelines
• Pediatric Bladder Scanning Guidelines
• Pediatric Bladder Management Protocol
• TRIP: CAUTI Prevention
B. Patient Education Resources
• UWHC HFFY Urinary Catheters and Urinary Tract Infections (#7355)
• UWHC HFFY Urinary Catheters and Urinary Tract Infections (Spanish - #7035)
• UWHC HFFY Urinary Catheters: Home Care (#7856)
• Urine Drainage Bags – Home Use (#4591)

Copyright © 201� University of Wisconsin Hospitals and Clinics Authority
Contact: Last Revised: 02/2017EArsenaultknudsen@uwhealth.org
3
• Urine Drainage Bags – Home Use (Spanish - #7035)
• UWHC HFFY The Tube That Drains Your Child’s Bladder (#7675)
• UWHC HFFY The Tube That Drains Your Child’s Bladder (Spanish - #7830)
• UWHC HFFY Urinary Catheter Placement in Diagnostic and Therapy Center (DTC)
(#6651)
• UWHC HFFY Self-Catheterization After Bladder Surgery for Women (#5916)
• UWHC HFFY After a Stroke, Managing Your Bladder (#6552)
• UWHC HFFY Catheterization, C lean Intermittent, Males (#4358)
• UWHC HFFY Catheterization, C lean Intermittent, Females (#4355)
• UWHC HFFY Urodynamic Testing (#5914)
C. Clinical Tools
• CAUTI Prevention Website on U-Connect
• CAUTI Prevention Bundle
IV. References
See full guideline document for list of references.
Centers for Disease Control and Prevention(CDC). (January, 2017). Urinary Tract Infection (Catheter-
Associated Urinary Tract Infection [CAUTI] and Non-Catheter-Associated Urinary Tract
Infection [UTI]) and Other Urinary System Infection [USI] Events. Retrieved from
https://www.cdc.gov/nhsn/PDFs/pscManual/7pscCAUTIcurrent.pdf.
V. Summary of Literature Used
Level of Evidence*
Number of
articles
I:
Systematic Reviews (integrative/meta-analyses), CPGs based on
systematic reviews / large multicenter clinical trials
5
II: Single experimental study (RCT’s) 8
III: Quasi-experimental studies 7
IV: Non-experimental studies 16
V: Case report/program evaluation/narrative literature reviews 19
VI: Opinions of respected authorities 29
*Levin, R.F. & Kaplan Jacobs, S. (2016). Developing and evaluating clinical practice guidelines: A
systematic approach In M. Boltz, E. Capezuti, T. Fulmer & D. Zwicker (Eds.), Evidence-based geriatric
nursing protocols for best practice 5
th
Edition (pp. 3-11). New York, NY: Springer Publishing Company,
LLC.